Scott Webb (Host): Uterine fibroids are common, but many women don't experience symptoms or symptoms that they associate with fibroids. And though at one time, full open surgery hysterectomies were the gold standard for the removal of fibroids, some doctors like my guest today are using the minimally invasive Acessa procedure with amazing results.

Host: And I'm joined today by Dr. Luann Racher. She's an OB-GYN, and she's the only gynecologist in the state of Arkansas that has achieved the minimally invasive practice focused designation through the American Board of Obstetrics and Gynecology.

This is UAMS Health Talk, the podcast from University of Arkansas for Medical Sciences. I'm Scott Webb. Doctor, thanks so much for your time today. We're going to talk about uterine fibroids, what they are, how they occur and what you're doing to treat them using the Acessa procedure, which we'll get to. But before we get there, just a little baseline here, what are Uterine fibroids and what kind of symptoms do women experience when they have them?

Dr. Luann Racher: Sure. So, uterine fibroids are muscular growths in the body of the uterus. And the uterus is also sometimes called the womb, that's where a pregnancy develops. And that's also where a woman has her monthly cycle from. And so whenever you have a muscular growth in the uterus itself, we call that a fibroid. And those can be very small, maybe less than a centimeter in size, or they can get very large, like the size of the basketball or larger. You can have one fibroid, you can have multiple fibroids. And they're fairly common. When we look at overall incidence of fibroids in women, about 80% of women will have at least one fibroid in their lifetime. But only about 60% of those women will have symptoms from their fibroids. So if you do have symptoms from fibroids, things that you can experience are heavy bleeding during your cycle. You can have irregular bleeding. And then, you can also have pain or pressure-type symptoms. Sometimes women don't even realize that they're having symptoms from their fibroids because we don't always associate things like urinary frequency or having the urge to go to the bathroom all the time or even constipation as pressure symptoms from our uterus. But you definitely can have some of those symptoms if you have large fibroids.

Host: Yeah. And I don't want to let this go by you. When you think about large fibroids, did you say as large as a basketball?

Dr. Luann Racher: Yes. Yes, they can get as large as a basketball or sometimes even larger.

Host: Oh, my goodness.

Dr. Luann Racher: And they grow very slowly. And so, sometimes they get that large without you ever even really realizing it, because they start off small and they grow slowly over time. So, you may think that you're just either gaining a little bit of weight or feeling a little bit sluggish because of normal aging things or not getting enough rest, but really you can end up with fibroids that weigh several pounds that you're pulling around and not even realize it.

Host: Well, that sounds entirely unpleasant for women, and I'm so glad that they have experts like yourself to help them. So, let's talk about the old school classic treatments for fibroids before we get to the Acessa procedure.

Dr. Luann Racher: Sure. Classically, women have undergone hysterectomy for treatment of fibroids. And I'm really excited and proud to be a minimally invasive surgical specialist and be able to offer surgeries that are not as invasive as the old-fashioned hysterectomy. If a woman had a basketball-sized fibroid in the past, we would have to do a big up and down incision on her abdomen and then remove that uterus completely. In the '70s and '80s even, they would take out the ovaries at the same time because "You don't need those," which spoiler alert you really do. And then, of course, you're looking at more blood loss, longer recovery time and more risk of infection with that big of a surgery.

As we've gotten better at minimally invasive approaches, now we're able to do hysterectomies in a minimally invasive fashion, which is great. And so for women who want a hysterectomy, we are able to offer that without that big up and down incision in the majority of cases now. There are also options of just removing the fibroid itself though. So, you can cut into the uterus, remove the fibroid from the uterus, and then repair that muscle of the uterus. And those are still done as well, and they definitely have their place. And in the past, we did those with a big open incision. Now, a minimally invasive specialist can do that by laparoscopy or robotic-assisted surgery.

And then, the third way that we have classically treated uterine fibroids is with a uterine artery embolization. And that's not performed by a gynecologist, that's performed by a specialized radiologist who makes an incision in the groin and then goes in through our vascular system to block blood flow to the uterus itself. And then, that causes the fibroids and the uterus to shrink over time, which can then improve the symptoms of fibroids. But I'm really excited to discuss the Acessa procedure today.

Host: So then, let's do that, doctor. Let's talk about the Acessa procedure. What is the Acessa procedure and how is it different from a uterine artery embolism?

Dr. Luann Racher: The Acessa procedure is performed by a gynecologist. It is performed in the operating room. So, the patient goes completely under anesthesia or is asleep for the procedure. We make two small incisions on the abdomen, and then we go in laparoscopically to insert needles into the fibroid itself, then we administer a dose of heat energy to basically kill that fibroid immediately. With a uterine artery embolism, we're decreasing the blood flow to the uterus into the fibroids, so the fibroid dies over time. And so, women who undergo a uterine artery embolism will have about three to six months where that fibroid is shrinking and dying. It can cause a lot of pain and cramping and even discharge. And it can be very uncomfortable for a lot of women. When we do the heat frequency or the heat energy ablation with the Acessa, the fibroid dies immediately. And so when the woman wakes up from surgery, that fibroid is already what we call undergoing necrosis. And so, it is already dead and will not cause any more pain. And so, it's a much less painful procedure to have than a uterine artery embolization.

Host: Yeah, I see what you mean. And it sounds like there's a lot of treatment options and perhaps some women with some surgeons would prefer the classic procedures, right? Don't mind the big scar, don't want a minimally invasive laparoscopic surgery with robotic assistance. Sure, I'm not here to judge. But for women who do want the Acessa procedure, who's a good candidate?

Dr. Luann Racher: Sure. So, a really good candidate for the Acessa procedure is someone who has one or multiple fibroids that are under eight centimeters in diameter each. And so, we can actually take the device and break a larger fibroid that's maybe six to eight centimeters and do it in smaller sections. But anything over about that eight centimeter mark is not going to have as good of a response as some of the smaller fibroids. So, a woman who has multiple medium-sized fibroids is a great candidate for this procedure.

It's also really great for the patient or the woman who wants a quick recovery time. So, you come in, we do this procedure, you go home the same day, you rest over the weekend, and you're back to normal activities by Monday morning. So, it really is a recovery time of about two to three days for this procedure.

Host: That's awesome. Always the million-dollar question with things like this is, does insurance cover Acessa?

Dr. Luann Racher: Yes. So, we actually are seeing insurance approval for most major insurance companies here in Arkansas and around the country. And so, really most insurances are covering it. So, we are able to offer this procedure to almost everyone.

Host: Yeah, that's nice. I don't know if it's because of COVID or what's happened, but it does seem like more and more insurance companies are just more willing, more apt to pay for things, especially when they're cutting edge, becoming the gold standard. And especially, when you talk about just how relatively short the procedure is, and the fast recovery time, people going home the same day, it just seems like such a benefit to everybody, doctors, patients, insurance companies. What can women expect afterwards? So, you say it's a pretty fast recovery time and they're back on their feet and doing stuff, whatever it might be. But what can they expect long-term afterwards?

Dr. Luann Racher: It's really interesting. Whenever I'm doing the Acessa in real time, I can actually watch the fibroid get smaller with my actual eyes. So, it's really cool. I can see someone come in with a really bulky uterus and even just immediately during the surgery, I can see an improvement in the size of those fibroids. And you get your maximum effects about 12 months after surgery because that fibroid will continue to shrink some. But it's something that you can see an immediate improval in. So, most women wake up from surgery and, when I do their followup call within about a week or less from surgery, I usually hear, "I'm already feeling back to my normal self. I've really had minimal pain and I can already tell a difference in the size or the bulkiness of my fibroids." Some women will require no more than ibuprofen or Tylenol. There are a few women who will need small amounts of pain medication. But overall, the pain after the procedure is really minimal.

Host: Yeah. And it just sounds to me, especially with medium to large fibroids, it just sounds like a game-changer really and such an improvement in terms of quality of life and everything else. I'm just still hung up on women carrying around basketballs down there and not even realizing that they're fibroids or not even realizing that there's treatment available, that there's anything really even wrong with them. It's really amazing. I'm wondering, do you recommend Acessa for women who are planning pregnancy,

Dr. Luann Racher: So as of right now, it does not have FDA approval for women who are planning pregnancy. We do not require that women agree to never carry a pregnancy if they have the Acessa done. There are some procedures that we counsel women heavily on you should not get pregnant after this type of procedure. But I don't have that type of recommendation for Acessa right now. It's such a new cutting edge procedure. We don't have any long-term, say, data. I can say that anecdotally we have a registry of women who have undergone Acessa and then gotten pregnant and have done very well. But I just don't have any long-term data that has been scientifically analyzed to the degree that the FDA will say that it's approved for that.

So again, it's a decision-making process between the woman and her surgeon if she's a good candidate. And desire of future pregnancy may or may not exclude her from that, but it's still worth the conversation.

Host: Yeah, worth a conversation. And this has been really educational today. I love the buzzwords that I hear often from podcast guests, minimally invasive, faster recovery, robotic-assisted. It's really all good stuff. So, thank you so much for your time. You stay well.

Dr. Luann Racher: Thank you. You too.

Host: And call 501-526-1050 to make an appointment. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for additional topics of interest.

This is UAMS Health Talk from the University of Arkansas for Medical Sciences. I'm Scott Webb. Stay well.